title: Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease is common and accounts for considerable healthcare expenditure. A large proportion of this healthcare expenditure is attributable to the use of expensive urgent healthcare. The characteristics of interventions that reduce the use of urgent healthcare remain unclear.
  
  
  OBJECTIVE
  To examine the characteristics of complex interventions intended to reduce the use of urgent and unscheduled healthcare among people with COPD.
  
  
  METHODS
  Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to 25th January 2013 were conducted. These were supplemented by hand-searching bibliographies and citation tracing identified reviews and eligible studies.
  
  
  METHODS
  Studies were eligible for inclusion if they: i) included adults with chronic obstructive pulmonary disease, ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up.
  
  
  METHODS
  Data on the subjects recruited, trial methods used, the characteristics of complex interventions and the effects of the intervention on urgent healthcare utilisation were extracted from eligible studies.
  
  
  RESULTS
  32 independent studies were identified. Pooled effects indicated that interventions were associated with a 32% reduction in the use of urgent healthcare (OR = 0.68, 95% CI = 0.57, 0.80). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.66, 95% CI = 0.55, 0.81), Exercise (OR = 0.60, 95% CI = 0.48, 0.76) and relaxation therapy (OR = 0.48, 95% CI = 0.33, 0.70).
  
  
  CONCLUSIONS
  Use of urgent healthcare in patients with COPD was significantly reduced by complex interventions. Complex interventions among people with COPD may reduce the use of urgent care, particularly those including education, exercise and relaxation.
authors.affiliation: Institute of Health Service Research, University of Exeter Medical School and Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), Universities of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter EX2 4SG, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Centre for Primary Care, Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK. Electronic address: amy.blakemore@nhs.net.
authors.forename: Amy
authors.initials: A
authors.lastname: Blakemore
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Angee
authors.initials: A
authors.lastname: Khara
authors.affiliation: Biostatistics Unit, Institute of Population Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Institute of Inflammation and Repair, University of Manchester, 2nd Floor Education and Research Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Woodcock
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Fryer
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
authors.forename: Else
authors.initials: E
authors.lastname: Guthrie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
keywords: Chronic obstructive pulmonary disease; Complex intervention; Long-term conditions; Meta-regression; Systematic review; Urgent healthcare utilisation